1/36. abdominal pain in children.Chronic vague abdominal pain is an extremely common complaint in children over 5 years, with a peak incidence in the 8 to 10 year group. In over 90 per cent of the cases no serious underlying organic disease will be discovered. Most disease states can be ruled out by a careful history, a meticulous physical examination, and a few simple laboratory tests such as urinalysis, sedimentation rate, hemoglobin, white blood count determination, and examination of a blood smear. If organic disease is present there are often clues in the history and the examination. The kidney is often the culprit--an intravenous pyelogram should be done if disease is suspected. barium enema is the next most valuable test. Duodenal ulcers and abdominal epilepsy are rare and are over-diagnosed. If no organic cause is found, the parents must be convinced that the pain is real, and that "functional" does not mean "imaginary." This is best explained by comparing with "headache"--the headache resulting from stress and tension hurts every bit as much as the headache caused by a brain tumor or other intracranial pathology. Having convinced the patient and his parents that no serious disease exists, no further investigation should be carried out unless new signs or symptoms appear. The child must be returned to full activity immediately.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
2/36. Erosive injury to the upper gastrointestinal tract in patients receiving iron medication: an underrecognized entity.Severe gastrointestinal necrosis and strictures after an iron overdose are well described. However, mucosal injury in patients receiving therapeutic iron has received only scant recognition despite its wide use. We studied the clinical and histologic features of 36 upper gastrointestinal tract biopsies from 33 patients (24 gastric, 9 esophageal, 1 gastroesophageal junction, and 2 duodenal) containing characteristic brown crystalline iron material, and evaluated the amount and tissue distribution of the iron. In addition, we investigated the prevalence of iron-associated mucosal injury in upper gastrointestinal endoscopic examinations. The majority of the biopsies (32 of 36, 89%) contained luminal crystalline iron adjacent to the surface epithelium or admixed with luminal fibrinoinflammatory exudate. Thirty biopsies (83%) showed crystalline iron deposition in the lamina propria, either covered by an intact epithelium, subjacent to small superficial erosions, or admixed with granulation tissue. Three biopsies (8%) demonstrated iron-containing thrombi in mucosal blood vessels. Erosive or ulcerative mucosal injury was present in 30 of 36 biopsies (83%). The amount of iron accumulation in cases with mucosal injury was greater than in cases without mucosal injury (mean grades, 2.4 vs. 1.3 on a 1 to 3 scale; p = 0.002). iron medication was confirmed in 25 of 33 patients (76%) 22 patients were receiving ferrous sulfate. Approximately half of the patients (17 of 33, 51%) also had underlying infectious, mechanical, toxic, or systemic medical conditions that could have initiated or exacerbated tissue injury. Crystalline iron deposition was found in 0.9% of upper gastrointestinal endoscopic examinations (12 of 1,300), and iron medication-associated erosive mucosal injury was present in 0.7% (9 of 1,300). These results indicate that crystalline iron deposition in the upper gastrointestinal tract is not uncommon. It can induce or exacerbate a distinctive histologic pattern of erosive mucosal injury, especially in patients with associated upper gastrointestinal disorders. Recognition of this pattern by pathologists and its communication to clinicians may aid in optimizing therapy.- - - - - - - - - - ranking = 1.6537798998827keywords = upper (Clic here for more details about this article) |
3/36. Gastric adenocarcinoma presenting with persistent, mild gastrointestinal symptoms in pregnancy. A case report.BACKGROUND: Mild gastrointestinal symptoms are common during pregnancy but can also be the only symptoms in stomach cancer until the late stage. Clinicians' reluctance to pursue diagnostic studies appears to be a major contributing factor to delayed diagnosis and poor outcome. We report a case of maternal death to alert clinicians to this rare possibility. CASE: A 36-year-old woman had persistent, mild epigastric discomfort, nausea, vomiting and frequent episodes of dark stools since the second trimester of pregnancy. These were attributed to peptic ulcer and an iron supplement given, without investigation. gastroscopy was performed only at 32 weeks of gestation, when the patient had heavy hematemesis. biopsy confirmed the diagnosis of poorly differentiated adenocarcinoma of the stomach. cesarean section was performed after steroid therapy. Advanced stomach cancer with stomach perforation was found. Curative surgery was not possible. The patient died four weeks after delivery. CONCLUSION: stomach cancer is a rare complication of pregnancy. Delay in diagnosis is commonly due to clinicians' reluctance to request diagnostic studies and the nonspecific symptoms of the disease. Early recognition and diagnosis are the only possibilities for a better outcome. Clinicians must be alert to this possibility and include this in the differential diagnosis of minor gastrointestinal discomfort during pregnancy.- - - - - - - - - - ranking = 1.7706733795225keywords = discomfort (Clic here for more details about this article) |
4/36. Complications of total abdominal and spleen irradiation in patients with lymphomas.Fifty patients with non-Hodgkin's lymphoma were treated with total abdominal irradiation to a dose of 3000 rad by anterior and posterior fields treated the same day. Fourteen patients developed complications, four with intestinal obstruction due to stenosis and three with total or partial intestinal irradiation damage. These bowel complications were only seen in patients who had previously had a laparotomy. The ways of preventing these complications are discussed. We have studied renal function by means of clinical examination, biologic and radiologic investigations, and scanning in 75 patients who have received splenic irradiation to a dose of 4000 rad. With a mean follow-up time of 36 months, this study has shown that there was no significant change in blood pressure or in biochemical measurements. However, at the 17th month, nephrotomograms demonstrated cortical atrophy of the upper role of the kidney; at the 8th month, low uptake in the irradiated area was seen on 197Hg neohydrine scanning and a decrease in renal plasma flow in the left kidney during dynamic studies with Hippuran.- - - - - - - - - - ranking = 0.18375332220919keywords = upper (Clic here for more details about this article) |
5/36. Rofecoxib-associated upper gastrointestinal bleed: a case report.To our knowledge, this is the first clinical report of a rofecoxib-associated upper gastrointestinal hemorrhage. We urge caution in prescribing rofecoxib to patients with risk factors for peptic ulcer disease and recommend limiting the dose to 25 mg per day for these patients.- - - - - - - - - - ranking = 0.91876661104594keywords = upper (Clic here for more details about this article) |
6/36. Severe upper gastrointestinal hemorrhage in the newborn.Three infants with severe upper gastrointestinal hemorrhage with esophagogastroduodenoscopic (EGD) findings were reported. The underlying conditions of these infants included Down's syndrome, hypoplastic left heart, and diaphragmatic hernia. The precipitating factors were identified in all cases, including prenatal stress, hypoxemia, prolonged ventilatory support, and gastroesophageal reflux. The EGD findings were composed of multiple gastric ulcers and a duodenal ulcer in the first 2 cases, whereas esophagitis and gastritis were noted in the last case. These ulcers were classified as secondary peptic ulcers. All cases responded well to medical treatment, including ranitidine, sucralfate, omeprazole, cisapride, and octreotide.- - - - - - - - - - ranking = 0.91876661104594keywords = upper (Clic here for more details about this article) |
7/36. Gastrojejunocolic fistula following surgery for peptic ulcer complications: two case reports.Two patients were admitted in the surgical unit--I of Mymensingh Medical College Hospital on January 2001 and March 2001 with the complaints of epigastric pain and discomfort, feculent eructation and fecal vomiting, diarrhoea with lienteric stools, weight loss and weakness. Both of them had previous history ulcer complications. The diagnoses of gastrojejunocolic fistula were made on the basis of history, barium enema examination and upper gastrointestinal endoscopy. Early resuscitation with correction of nutritional deficiencies, fluid and electrolyte imbalance was attempted along with blood transfusion, antibiotics and other supportive measures. But the first patient was too ill to cope up with the treatment and developed cardio-respiratory symptoms. A single stage procedure comprising of partial gastrectomy along with resection of the fistula and restoration of bowel continuity (by jejunojejunostomy, colocolostomy and closure of duodenal stump) was adopted in both patients. Early postoperative recovery was good in both but the first patient expired on 8th postoperative day from acute myocardial infarction, while the second one developed anastomotic leakage and wound infection, which were managed conservatively. On follow up the second patient was found in sound health till to date after his discharge from the hospital.- - - - - - - - - - ranking = 1.0690900119704keywords = discomfort, upper (Clic here for more details about this article) |
8/36. Recurrent nonvariceal upper gastrointestinal bleeding in a patient with gastroduodenal schistosomiasis.In this case report, we describe the rare situation of a patient with nonvariceal upper gastrointestinal bleeding induced by gastric and duodenal involvement of schistosoma mansoni infection. In this unique case severe, recurrent upper gastrointestinal bleeding was induced by central ulcerations of gastric pseudopolypoid and duodenal polypoid lesions. However, very atypically, there were no signs of portal hypertension, coagulopathy, or variceal bleeding, and no macroscopic evidence of lower gastrointestinal tract involvement. Neither anti-ulcer therapy nor endoscopic hemostasis methods were effective in preventing recurrent bleeding episodes. Finally, typical histological and serological tests (positive for S. mansoni hemagglutination) led to the correct diagnosis, and the patient was completely cured by specific antischistosomal therapy.- - - - - - - - - - ranking = 1.1025199332551keywords = upper (Clic here for more details about this article) |
9/36. Thoracoscopic vagectomy for recurrent peptic ulcer disease.Duodenal and marginal jejunal ulcers respond promptly to vagus section. When a prior gastric drainage procedure has been done, the approach of choice for these ulcers is vagectomy through the left chest. This report describes four patients who were subjected to thoracoscopic vagectomy and had prompt early benefit. A description of our technique is presented.- - - - - - - - - - ranking = 0.0037729200800351keywords = chest (Clic here for more details about this article) |
10/36. peptic ulcer-induced acute aortogastric fistula occurring 7 years after a pharyngogastrostomy following a resection for carcinoma of the esophagus: report of a case.A 46-year-old woman underwent a pharyngogastrostomy, following a laryngoesophagectomy for esophageal carcinoma. Although she had been disease-free for 7 years, she subsequently was admitted to undergo a workup due to fever along with chest and back pain. A few days after admission, the patient suddenly vomited a large volume of blood and went into shock. Bleeding was stopped with a Sengstaken-Blakemore tube, and an emergency thoracotomy was performed. A fistula between the thoracic aorta and an ulcer of the gastric tube was identified. We decided to close the aortic lesion directly because the adhesions were extremely dense and her blood circulation was poor. One week later, we resected the thoracic part of the gastric tube, debrided the fistula, and wrapped the aortic lesion with a patch. However, on the 18th postoperative day, she developed massive hematemesis due to rupture of an infected pseudoaneurysm in the thoracic aorta and died.- - - - - - - - - - ranking = 0.0037729200800351keywords = chest (Clic here for more details about this article) |
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